Provider Demographics
NPI:1104130053
Name:GREENFIELD, JERRY (LPN)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GAUGUIN CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2001
Mailing Address - Country:US
Mailing Address - Phone:631-924-1374
Mailing Address - Fax:
Practice Address - Street 1:51 GAUGUIN CT
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2001
Practice Address - Country:US
Practice Address - Phone:631-924-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253928164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY253928OtherLPN